HIV impacts some communities more than others. Examples include men who have sex with men, trans women, people who inject drugs, and Black and Indigenous communities.
In 2018, it was estimated that around 62,000 people were living with HIV in Canada. Assuming growth at the current rate (most likely undercounting), this number is estimated to be about 68,000.
The new number of HIV cases has been increasing since 2014. In 2019 there were 2,122 new HIV cases diagnosed. In 2020, there were 1,639 new HIV cases diagnosed. This drop is likely because people had less access to HIV testing during COVID-19 lockdowns.
Men who have sex with men make up the largest group of new HIV diagnoses each year, but the data shows that this lead is slowly lessening.
The Public Health Agency of Canada measures the annual rate of new HIV diagnoses per 100,000 people.
The provinces with the highest HIV rates (per 100,000 people) are Saskatchewan (16.9), Manitoba (8.8), and Quebec (7.4).
The major cities with the highest HIV rates (per 100,000 people) are Toronto (17.4), Saskatoon (16.3) and Vancouver (12.6). Prince Albert has the highest recorded HIV rate of all cities at 56.4 cases per 100,000.
Saskatchewan is the only province where most new HIV cases diagnosed are with individuals who inject drugs.
To understand how common HIV is in Canada, we need to get into some statistics. We know nobody likes math, but bear with us!
If you’ve been watching the news during the COVID-19 pandemic, you’ll know that tracking a disease is complicated. This difficulty is because diseases don’t always affect all communities equally.
For example, the overall percentage of people with COVID-19 who are hospitalized is low. But if we look at the number of older people who are hospitalized with COVID-19, the rate is higher. Discrepancies like this are how we can tell that COVID-19 is more serious for elderly people.
We know that HIV impacts some communities more than others: men who have sex with men, trans women, people who inject drugs, and Black and Indigenous people. If someone is outside these groups, they might never meet someone with HIV.
If you’re in a community affected by HIV, though, you could know more people living with it. This is what we call a “burden” - it’s where one group of people faces higher rates of a disease than everyone else.
“Burden” is a term from epidemiology, the study of diseases and how they spread. We’ve all become more aware of science-y concepts like “flatten the curve” during COVID-19 - some of these terms can also help us understand HIV in Canada.
There are two valuable keywords here: “prevalence” and “incidence.”
Prevalence means the number of new cases in a time period, showing how fast a disease is spreading.
Incidence means how many people have a disease in a time period, which shows us its overall impact.
In Canada, we can break prevalence & incidence down by province and city. We can also break them down by population to see how HIV affects some communities more than others.
Not everyone who has HIV knows their status, so the Public Health Agency of Canada uses the data they have to make an estimate. In 2018 they estimated that around 62,000 people in Canada were living with HIV.
Since 2014, the HIV prevalence in Canada has been increasing (i.e. the number of new cases each year has been going up).
The most recent accurate data was from 2019, when there were 2,122 new diagnoses. In 2020 there were 1,639 new diagnoses, but this drop is likely because people had less access to HIV testing during COVID-19 lockdowns. If numbers continued through 2021 at their previous rate, we could estimate that there are now around 68,000 people in Canada living with HIV.
The Public Health Agency of Canada measures the annual rate of new HIV diagnoses per 100,000 people. It provides a rate for the country and provinces/territories, and it’s important to look at both. This is because there are considerable differences in HIV prevalence between regions.
In 2019 this national rate was 5.6 people living with HIV per 100,000.
Four regions were below this average: Northwest Territories (1.7), Atlantic Canada (3), B.C. (3.5) and Ontario (4.7).
Alberta is close to average (5.8), followed by Quebec (7.4) and Manitoba (8.8).
Saskatchewan has the highest prevalence, at 16.9 people per 100,000. Indigenous people in this province face a huge burden of HIV, and Saskatchewan is the only province where most new diagnoses are among people who inject drugs.
HIV rates can vary by city, and these numbers tend to be higher than in rural areas. The available data is usually for new HIV cases per year out of 100,000 (prevalence). The following numbers come from 2017 to 2019.
Cities tend to have a prevalence above their provincial average and the national average (5.6 per 100,000).
The major cities with the highest HIV rates are Toronto (17.4), Saskatoon (16.3) and Vancouver (12.6).
These are followed by Montreal (9.1), Edmonton (8.4) and Ottawa (8). London has a rate of 6.1, and Calgary is slightly below average at 5.3.
Prince Albert has the highest recorded HIV rate of all Canadian cities at 56.4 per 100,000.
The HIV data that we have in Canada is broken down by population. This groups people together by “exposure category,” meaning the way they probably acquired HIV. The main categories are through sex between men, injecting drugs and heterosexual sex.
We know that trans women are particularly affected by HIV, but researchers have historically neglected this group regarding data collection. This has a real-world impact because a lack of data can make it harder to tailor HIV prevention to trans women in Canada. Things are slowly improving, though, and HIV research is becoming more inclusive.
Around half of people living with HIV in Canada are gay, bisexual and other men who have sex with men (MSM). MSM make up the biggest group of new HIV cases each year, but data shows that this proportion is slowly decreasing. On the other hand, new cases among women, people who inject drugs and Indigenous people are going up.
One-quarter of people living with HIV in Canada are cis women, and in 2020 they were 30% of new cases. A third of these women were exposed to HIV by injecting drugs, and two-thirds were exposed by heterosexual sex.
Some communities have a much higher HIV burden than others.
MSM are only 3-4% of the adult male population, but in 2018 they were 49% of new cases.
Indigenous people are only 4.9% of the Canadian population, but were 14% of new cases the same year.
The data we have can sometimes be limiting - for example, people can sometimes fall into multiple categories, like racialized people who inject drugs or queer people of colour. In this case, they will experience an even higher burden of HIV.
Yes! Until 2018, people living with HIV faced challenges when immigrating to Canada because their HIV treatment was deemed an “excessive demand” on the healthcare system.
Potential immigrants are required to take a medical examination and tests (including HIV); the results are then used to calculate how much someone’s healthcare will cost the government each year.
In 2018, Immigration, Refugees and Citizenship Canada raised the cut-off from $6,604 to $19,812 per year. This now covers many HIV treatments, which come under this maximum.
References
HIV in Canada: 2020 Surveillance Highlights, Public Health Agency of Canada (2021)
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-2020-surveillance-highlights.html
HIV in Canada: 2019 Surveillance Highlights, Public Health Agency of Canada (2020)
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-2019-surveillance-highlights.html
The Epidemiology of HIV in Canada, CATIE (2021)
https://www.catie.ca/the-epidemiology-of-hiv-in-canada#numbers
Estimate of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 targets, Public Health Agency of Canada (2020)
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html#s7
People Living with HIV in Canada, Public Health Agency of Canada (2020)
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-canada.html
Programme de surveillance de l’infection par le virus de l’immunodéficience humaine (VIH) au Québec : rapport 2019, Institut national de santé publique du Québec (2019)
https://www.inspq.qc.ca/publications/2706
HIV Annual Report, BC Centre for Disease Control (2017)
http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/HIV_Annual_Report_2017_FINAL.pdf
T.O. Health Check, Toronto Public Health (2019)
https://www.toronto.ca/wp-content/uploads/2019/11/99bb-TOHealthCheck_2019Chapter9.pdf
Alberta Sexually Transmitted Infections and HIV 2019, Alberta Health (2020)
https://open.alberta.ca/dataset/c6850032-20d3-4845-a465-568ed7e61b7c/resource/97740102-55a8-4f87-9b9e-7dc0901e411f/download/health-alberta-sexually-transmitted-infections-and-hiv-2019.pdf
Infectious Diseases Data, Ottawa Public Health (2020)
https://www.ottawapublichealth.ca/en/reports-research-and-statistics/infectious-diseases.aspx#Human-Immunodeficiency-Virus-HIV-
HIV & AIDS in Saskatchewan (2019), Government of Saskatchewan
https://publications.saskatchewan.ca/api/v1/products/109306/formats/122818/download
